CAJ | 학술논문

　　目的探讨高危HPV检测及宫颈环形电切术（LEEP）在诊治宫颈上皮内瘤变（CIN）及早期宫颈癌中的价值。方法回顾性分析183例行高危HPV检测、阴道镜下宫颈多点活组织检查和宫颈环形电切术患者的临床资料，研究高危HPV检测在CIN诊治中的价值，对比阴道镜下宫颈多点活组织病理检查和宫颈环形电切术病理结果的差异，并随访术后2年内复发情况。结果随着CIN级别的升高，高危HPV阳性率升高。高危HPV阳性患者LEEP术后病变复发率10.4%（14/134），高危HPV阴性组无一例复发。阴道镜下宫颈多点活组织病理检查与宫颈环形电切术病理结果完全符合98例（53.6%）；术后诊断升级32例（17.5%），复发14例（7.7%）；子宫切除治疗24例，升级和复发病例均行相应补充治疗。CIN患者采用宫颈环形电切术、子宫切除治疗2年有效率达92.3%。阴道镜活检浸润癌漏诊率为4.9%（9/183），宫颈环形电切术后切缘阳性率为15.8%（29/183）。结论高危HPV检测对CIN患者LEEP术后复发的预测有很高的灵敏度。阴道镜检查多点活检早期诊断CIN具有较高的准确性。宫颈环形电切术具有手术时间短，出血量少，切净率高的优点，是CIN的主要治疗方法，其对CIN和早期宫颈浸润癌的诊断率高。
　　목적탐토고위HPV검측급궁경배형전절술（LEEP）재진치궁경상피내류변（CIN）급조기궁경암중적개치。방법회고성분석183례행고위HPV검측、음도경하궁경다점활조직검사화궁경배형전절술환자적림상자료，연구고위HPV검측재CIN진치중적개치，대비음도경하궁경다점활조직병리검사화궁경배형전절술병리결과적차이，병수방술후2년내복발정황。결과수착CIN급별적승고，고위HPV양성솔승고。고위HPV양성환자LEEP술후병변복발솔10.4%（14/134），고위HPV음성조무일례복발。음도경하궁경다점활조직병리검사여궁경배형전절술병리결과완전부합98례（53.6%）；술후진단승급32례（17.5%），복발14례（7.7%）；자궁절제치료24례，승급화복발병례균행상응보충치료。CIN환자채용궁경배형전절술、자궁절제치료2년유효솔체92.3%。음도경활검침윤암루진솔위4.9%（9/183），궁경배형전절술후절연양성솔위15.8%（29/183）。결론고위HPV검측대CIN환자LEEP술후복발적예측유흔고적령민도。음도경검사다점활검조기진단CIN구유교고적준학성。궁경배형전절술구유수술시간단，출혈량소，절정솔고적우점，시CIN적주요치료방법，기대CIN화조기궁경침윤암적진단솔고。
Objective To study the clinical value of high-risk human papilloma virus (HPV) detection and loop electrosurgical excision procedure (LEEP) in the treatment of cervical intraepithelial neoplasia (CIN) and early cervical cancer. Methods The clinical datas of 183 patients who underwent high-risk HPV testing, vaginoscope multiple biopsies and cervical conization were analysed. The value of high-risk HPV testing had been researched in the diagnosis and treatment of CIN. The results between vaginoscope multiple biopsies and cervical conization was compared. All patients were followed-up for two years. Results In the rising of CIN level and high-risk HPV prevalence, the recurrent rate of patients with high-risk HPV infection taking LEEP was 10.4%(14/134). The recurrent rate of the patients without high-risk HPV infection taking LEEP was zero. The pathology results of LEEP were completely consistent with the pathology results of vaginoscope multiple biopsy in 98 cases (53.6%). The pathological level rose up after LEEP in 32 cases (17.5%), and 14 cases (7.7%) had a recurrence. 24 patients received hysterectomy and all the other cases whose pathological level upgraded or who experienced recurrence received additional treatment. The effective rate of conization treatment and hysterectomy on all CIN patients reached 92.3%. The omission diagnostic rate of colposcopy guided biopsy on invasive carcinoma was 4.9%(9/183), and the residual rate of the patients taking conization was 15.8%(29/183). Conclusion High-risk HPV testing had a high sensitivity in predicting the recurrence of CIN patients taking LEEP. Colposcopy including multi-point biopsy had high accuracy in the early diagnosis of CIN. Cervical conization had many advantages such as simple, short operation time, little hemorrhage and high excision rate, which played a very important role in diagnosis of CIN and early cervical cancer.